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St Josephs Healthcare_ Hamilton Manual Corporate Policies

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					St. Joseph’s Healthcare,          Manual          Section           Pages       Number
Hamilton                          Corporate       Administrative    1 of 13     100-ADM
                                  Policies
Subject                                                             Date:
PREVENTION OF VIOLENCE IN THE WORKPLACE                             December 11, 2006
Supersedes              Cross Reference: 029-HR                     Issuing Authority:
                        Harassment, 006-OH&S                        Executive Team
                        Employee Incident/Accident
                        Reporting & Investigation,
                        010-OH&S Workplace Health
                        and Safety Inspections, 044-
                        ADM Code White
                        040-ADM – Compliments and
                        Complaints
                        045-ADM – Incident Mgmt.-
                        Patients/clients and Visitors,
                        034-ADM –Laying of Criminal
                        Charges, 087-ADM –
                        Notification of Police, Fire
                        Department, Office of the Fire
                        Marshall
                        090-ADM – Privacy of Personal
                        Information
                        Code White – Violent Situation
                        Code Purple – Hostage Plan
                        SW Policy – Intimate Partner
                        Violence
    Charlton Site                     CMHS                              CAHS

Purpose:
St Joseph’s Healthcare Hamilton (SJHH) is committed to the prevention of violence in the
workplace. SJHH shall take every precaution reasonable to provide a healthy, safe, secure and
violence free workplace environment for employees, patients/clients, visitors, members of the
professional staff, learners, contractors and volunteers. Violent or abusive behaviour will not be
tolerated. Action will be taken to protect the individuals involved.

Scope:
This policy applies to all patients/ clients, employees, members of the professional staff,
volunteers, visitors, learners, contractors and all persons who have a relationship with SJHH.


Definitions:
Assault
Assault is any intent to inflict physical injury on another, coupled with an apparent ability to do
so; any intentional display of force that causes the victim to fear immediate bodily harm.
Bullying
Bullying involves repeated demeaning and downgrading behaviour through vicious words and
cruel acts such as belittling, coercion, threatening, intimidation, undermining individuals,
blaming, fear and professional humiliation that gradually undermines confidence and self-
esteem.

Harassment
Harassment is defined as engaging in a course of vexatious comment or conduct that
is known, or ought reasonably to be known, to be unwelcome (and which causes a
person to feel humiliated or degraded).

Physical Attacks
Physical attacks include hitting, shoving, pushing, biting, pinching or kicking the victim, or
inciting a dog to attack.

Psychological Abuse
Psychological abuse is an act that provokes fear or diminishes an individual’s dignity or self
worth or that intentionally inflicts psychological trauma on another.

Poisoned Work Environment
Poisoned work environment is a hostile and abusive work environment resulting from
harassment by comment or conduct that ridicules or demeans an individual or specific group of
individuals, for example, racial slurs or derogatory comments about sexual orientation. (Refer to
SJHH Harassment and 029-HR Policy).

Sexual Abuse/Harassment
Sexual abuse/ harassment is any unwelcome verbal or physical advance or sexually explicit
statement, such as jokes, displays of pornographic material, pinching, brushing against,
touching, patting, or leering that makes a person feel humiliated, intimidated, or uncomfortable,
thus interfering with work performance.

Sexual assault
Sexual assault is the use of threat of violence to force one individual to touch, kiss, fondle, or
have sexual intercourse with another.

Threat
Threat (verbal or written) is a communicated intent to inflict physical or other harm on any
person or to property by some unlawful act. A direct threat is a clear and explicit
communication distinctly indicating that the potential offender intends to do harm, for example,
“I am going to make you pay for what you did to me.” A conditional threat involves a condition,
for example, “If you don’t leave me alone you will regret it.” Veiled threats usually involve body
language or behaviours that leave little doubt in the mind of the victim that the perpetrator
intends to harm. Threats of any nature can lead individuals to feel unsafe in their work
environment. These feelings may or may not be related directly to any specific threat.



                                                                                          Page 2
Violence in the Workplace
Violence is a threat or an act of aggression resulting in physical (including property damage) or
psychological damage, pain, or injury to an employee inflicted on that employee by
patients/clients or by patients/clients’ families or visitors.

Verbal Abuse
Verbal abuse is the use of vexatious comments that are known, or that ought to be known, to
be unwelcome, embarrassing, offensive, threatening or degrading to another person (including
swearing, insults or condescending language).

Workplace
Any location either permanent or temporary where an employee performs any work-related
duty. This includes but not limited to the buildings and the surrounding perimeters, including
the parking lots, field locations, clients’ homes and traveling to and from work assignments.


Acceptable Standards of Behaviour:
SJHH believes that all persons have the right to be treated with courtesy, dignity and respect,
and as such, SJHH believes that all individuals have the responsibility to treat others with
courtesy, dignity and respect. Sexism, racism, harassment and other forms of aggressive
behaviour will not be tolerated.

The following are some examples of behaviours that are not acceptable:
   Violence towards employees, patients/clients or visitors
   Threats or threatening behaviour
   Intrusive conversation or shouting
   Threatening or abusive language involving excessive swearing or offensive remarks
   Racist or sexist behaviour or language
   Willful damage to St. Joseph’s Healthcare Hamilton (SJHH) property

The Occupational Health & Safety Act (OHSA) Section 28(2)(b) provides that “no worker shall
use or operate any equipment, machine, device or thing or work in a manner that may
endanger himself/herself or any other worker.”

Any person found to be in violation of this policy, in the perpetration of violence or in the failure
to report it, may be subject to disciplinary measures up to and including termination of his/ her
relationship with SJHH.


Commitment - Roles and Responsibilities
    a.   Senior Management shall:
             Review recommendations brought forward, make decisions and communicate
             the plan.
             Ensure all persons who have a relationship with SJHH are aware of this policy
             Ensure the training and education of all employees
             Encourage reporting of behaviour that is not acceptable
             Integrate safe behaviour into day-to-day operations

                                                                                             Page 3
        Review reports of violence and/ or threats of violence in a prompt, objective
        and sensitive manner. This includes a review of all investigations associated
        with violence-related incidents. This shall be performed by the appropriate
        Vice President(s)/delegate(s)
        Ensure the provision of appropriate timely response measures, including
        corrective action, assistance to victim(s)
        Take every precaution reasonable in the circumstances for the protection of
        the worker (OHSA, Section 25 (2)(h)).

b.   The Director/Manager/Supervisor shall:
        Enforce policy and procedures and monitor compliance
        Ensure their employees complete education and training relating to this policy
        Ensure appropriate employees attend Crisis Prevention Institute (CPI)
        Nonviolent Crisis Intervention training
        Encourage reporting of behaviour that is not acceptable
        Inform appropriate Director/VP of incident of violence in the workplace
        Investigate all actual and potential incidents of workplace violence using the
        organization’s accident investigation procedure (006-OH&S Employee
        Incident/ Accident Reporting & Investigation and Patient and Visitor Incident
        Management Policy 045-ADM) and ensure appropriate measures are taken to
        safeguard all and curtail the violence.
        Track and analyze violence in the workplace incidents relevant to his/ her
        areas/units
        Make recommendations, following incident review, in a timely manner to the
        appropriate Director/Vice President
        Take every precaution reasonable in the circumstances for the protection of
        the worker (OHSA Section 27 (2)(c)).

c.   Patients/clients , Family Members, Visitors shall:
        Adhere to SJHH policies, including The Prevention of Violence in the Workplace
        policy.
        Be observant of any behaviour that could escalate into a crisis situation.
        Report to members of the clinical team all incidents of violence or situations
        that could escalate into a crisis.
        Patients/clients or visitors found to be engaged in conduct constituting violence
        are subject to remedy up to an including removal of visitation rights or
        discharge, if appropriate. The clinical team will assess and ensure that the
        appropriate interventions/actions are taken.

d.   The Professional Practice Leader/Advisor or delegate (related to Learners) shall:
        Enforce policy and procedures and monitor clinical educator/ preceptor and
        learner compliance
        Ensure their clinical educators/ preceptors and learners complete education and
        training relating to this policy
        Investigate all actual and potential incidents of workplace violence using the
        organization’s accident investigation procedure (006-OH&S Employee
        Incident/ Accident Reporting & Investigation and Patient and Visitor Incident

                                                                                 Page 4
        Management Policy 045-ADM) and ensure appropriate measures are taken to
        safeguard all and curtail the violence.
        Track and analyze incidents relevant to their discipline
        Report any incidents to the Academic Services Coordinator and the
        College/University/School/Vocational School of the learner
        Encourage reporting of behaviour that is not acceptable

e.   Employee, volunteer, learner and member of the Professional Staff shall:
       Be observant of any behavior that could warrant intervention or escalate into a
       crisis situation.
       Report concerns to his/ her manager/ supervisor or Professional Practice
       Leader/Advisor (or delegate).
       Attend non-violence crisis intervention training (CPI) if required.
       Utilize non-violent crisis intervention de-escalation techniques to assist in the
       prevention of violent situations
       Be observant of workplace hazards that could increase safety risk and report
       those immediately to his/her manager/supervisor
       Complete the Employee Incident and Accident Report and/or the Patient/Visitor
       Report
       Comply with this policy and all related procedures

     The Occupational Health & Safety Act (OHSA) Section 28(2)(b) provides that “no
     worker shall use or operate any equipment, machine, device or thing or work in a
     manner that may endanger himself/herself or any other worker.”

     Employees are encouraged to inform their manager/ supervisor/ the designated
     Human Resource manager and/ or Union Representative and learners are
     encouraged to inform their Professional Practice Leader/ Advisor/ delegate if they
     are involved in a non-work related or domestic situation, which may pose a risk to
     the individual and/ or the workplace. In doing so, employees may seek assistance
     or support from (and/or be accompanied) any person of their choice, including a
     Union Representative.

f.   Human Resources shall:
       Ensure the provision of an Employee Assistance Program (EAP) for employees
       and their families
       Ensure that SJHH has appropriate complementary policies and procedures that
       support this policy (i.e. recruitment policies and procedures including reference
       checks, EAP policies and procedures, etc.)
       Support employee as appropriate

g.   Occupational Health and Safety Services (includes Employee Health Office Staff)
     shall:
       Provide the necessary care to injured individuals and refer to appropriate
       resources for further care (i.e. EAP, other)
       Upon request of the manager/ delegate, act as resource
       Ensure appropriate investigation including where there are incidents of

                                                                                Page 5
                violence where an employee is critically injured or killed (under Occupational
                Health and Safety Act, OHSA)
                Track, analyze and report incidents to Joint Occupational Health and Safety
                Committees and Senior Management
                Notify the appropriate Union and director of each incident of violence in the
                workplace

      h.     Joint Health and Safety Committee shall:
                 Review reported incidents of violence in the workplace (including hazardous
                 situations)
                 Conduct investigations of incidents of violence in the workplace that are
                 deemed to be Critical Injuries as defined by the OHSA. (Critical injury: An
                 injury of a serious nature that a) places life in jeopardy, b) produces
                 unconsciousness c) results in a substantial loss of blood d) involves the
                 fracture of a leg or arm but not a finger or toe e) involves the amputation of a
                 leg, arm, hand or foot but not a finger or toe f) consists of burns to a major
                 portion of the body or g) causes the loss of sight in an eye. (RR) 1990 Reg.
                 834.
                 Make recommendations as appropriate (including but not limited to education,
               training, policies and procedures)
                 Review Summary Reports prepared for JOH&S Committee meetings
                 Participate in annual review of this policy and program (development,
                implementation and evaluation)

      i.     Prevention of Violence in the Workplace Steering Committee shall:
                Review and evaluate the program components annually
                Review complementary policies to ensure alignment with philosophy of
                Prevention of Violence in the Workplace Program
                Monitor trends and make recommendations for further program development

      j.     Unions shall:
                Provide input and support for SJHH Prevention of Violence in the Workplace
                policy and program development
                Encourage and support members to comply with SJHH’s Prevention of Violence
                in the Workplace policy and program
                Provide appropriate representation for their members, as requested by their
                members, at any stage of the process.


Reporting of Hazardous Situations, Employee I ncidents and Patient/ Visitor
Incidents:
   Employees shall immediately report all hazardous situations and incidents to their manager
   and complete the SJHH Hazard/ Employee Incident Report. create a hyperlink here right to
   the form if someone clicks on it. (Refer to policy 006-OH&S).
   If the incident involves a visitor or patient, complete the HIRS report create hyperlink here
   to this form also as per SJHH Policy (045-ADM).


                                                                                         Page 6
Education and Training:
All employees, volunteers and learners shall be provided education and training on the
Prevention of Violence in the Workplace Program. This includes all applicable policies (refer to
cross reference section of this policy for examples).

When an Incident Occurs:
    Every employee, volunteer and learner is responsible for immediately reporting incidents
    of workplace violence to his/ her manager/ supervisor and Professional Practice
    Leader/Advisor/delegate respectively.
    Every supervisor/ manager and Professional Practice Leader/ Advisor/ delegate is
    responsible for responding promptly to reports of workplace violence and complete and
    document a comprehensive investigation including recommendations for prevention.


Reporting/Response:

      Patient/Client/Visitors
      Immediate Action
        o Inform staff immediately of safety concerns.
        o If patient/ client/ visitor injured refer to 045-ADM – Incident Management-Patients
            and Visitors, 099-ADM – Critical Incident Management - Patient and Visitor, 066-
            OH&S – Employee Incident/Accident Reporting & Investigation.

      Employee
      Immediate Action – If Feels Unsafe
         o Removes self and others to a safe area if appropriate
         o Calls Code White as appropriate (Charlton dial ext. 3000, CAHS dial ext. 8000,
             CMHS dial ext. 222)
         o Calls 911 if appropriate
         o Remains calm, do not panic
      Notification
         o Notifies immediately his/ her manager/ delegate (specifically speaks to
             manager/delegate). Should page manager/delegate if not available in person.
      Assessment/Treatment
         o The employee obtains medical/ nursing assessment/ consultation from Employee
             Health Office nurse/ physician, emergency dept, or family practitioner with the
             assistance of the manager/delegate.
      Support (Individual)
         o Employees may contact Employee Assistance Program (EAP) 24 hours per day by
             contacting 905-521-8300 for CMHS; 905-304-0166 for CAHS and SJH.
         o The manager/ supervisor and union representative is available for assistance as
             required by the employee.
         o Further ongoing/post incident support is available from EHO nurse, physician, and
             other OH&S team members.
      Support (Colleagues/Patients/clients /etc.)
         o The manager/ supervisor is available to provide/facilitate support to
             coworkers/patients/clients /others.

                                                                                        Page 7
Other Actions
   o Notifies manager/supervisor and/or union representative of police involvement.
Documentation
   o Completes the employee descriptive section of the Employee Incident Report
      (006-OH&S – Employee Incident/Accident Reporting & Investigation).


Manager/Supervisor
Immediate Action
   o Ensures safety of all persons in area (employees, patients/clients, visitors, etc.).
Notification
   o For critical injuries ( immediately notifies his/her director/VP and administrator-on-
       call after hours/ weekends. Director/VP/administrator-on-call notifies Manager,
       Occupational Health and Safety, and Risk Manager. Community Relations and
       Marketing staff is available as required. Note: for critical injuries scene must not
       be disturbed.
   o notifies security as required
   o Notifies Emergency Room(ER) Manager/ Delegate/ charge nurse when staff is
       being referred to ER.
Assessment/Treatment
   o Facilitates medical/ nursing assessment/ treatment of persons involved (EHO
       nurse/physician; 911, emergency, etc.).
Support (Individual)
   o Facilitates a contact with EAP if appropriate and desired by employee.
   o Facilitates a contact with union executive if employee requests.
   o Facilitates contact with supports identified by employee.
   o Facilitates accompaniment for staff if ER care required.
Support (Colleagues/Patients/Clients/etc.)
   o Facilitates contact with EAP if appropriate and desired by employees.
   o Reviews with clinical team patient care needs and develops plan.
   o In consultation with clinical team, reviews and assesses the needs of co-workers,
       other patients/clients, family members, visitors present at time of incident in order
       to provide the appropriate support.
Documentation
   o Completes a thorough Incident/ Accident investigation and prepares a report that
       includes recommended corrective action.
   o Completes the manager/delegate section of the Employee Incident Report form
   o Ensures that the employee/ descriptive section of the Employee Incident Report is
       complete
   o Implements the recommended corrective action included in the Incident/ Accident
       report.


Occupational Health Nurse
Immediate Action
  o Assist at site of incident if requested by Manager/co-worker
  o Provide immediate care including first aid

                                                                                    Page 8
   o Facilitate referral to emergency if required and notify Emergency Dept
       Manager/charge nurse
   o Provide counseling
   o Assist in referral to EAP, Occupational Health Physician, Family Physician
   o Provide EAP card/contact information
   o Arrange for transportation (hospital transportation or cab) for medical care
   o Arrange for accompaniment as appropriate
   o Arrange/provide transportation/ for return to work or home or other
   o Contact employee within 24 hours (Monday to Friday) or (next business day) of
       being notified
Notification
   o Notify Manager/delegate and Manager OH&S immediately if incident is “critical
       injury” under OHSA
   o Verify with Manager that outlined reporting has been completed
   o Clarify with Manager further action and by whom (i.e. notifying relative, etc.)
   o Initiate internal reporting as per OH&S Services Policies and Procedures


Human Resources Manager
Immediate Action
   o If employee goes to Human Resources first, clarify with employee that employee
       has notified manager/delegate of incident
   o Provides advice to the manager/ supervisor to ensure safety of all persons in the
       area (employees, patient, visitors, etc.)
Notification
   o For serious incidents, communicates with the manager/ supervisor to ensure that
       his/her union (if applicable), VP of Human Resources, director/ VP and
       administration-on-call after hours/weekend have been notified.
   o Assists the manager/ supervisor to ensure that all appropriate people have been
       contacted (i.e., Director, Community Relations and Marketing, Manager
       Occupational Health and Safety, and Risk Manager).
Assessment/Treatment
   o Communicates with the manager/supervisor to ensure that the employee involved
       has received medical/ nursing assessment/ treatment (EHO, nurse/ physician,
       emergency, etc.).
Support (Individual)
   o Communicates with and assists the manager/ supervisor, where appropriate to
       ensure that contact with EAP, union representation and supports identified by
       employee have been made.
Support (Colleagues/Patients/Clients, etc.)
   o Reviews with the manager/ supervisor any need for follow-up support strategies
       i.e. team debriefing.




                                                                                Page 9
OH&S Manager
Immediate Action
   o Provide consultation to manager and Occupational Health Nurse .
   o Provide assistance to manager relating to accident investigation and follow-up of
       corrective actions recommended as result of investigation.
Notification
   o Ensure timely reporting to external governing bodies (WSIB, MOL).
   o Ensure timely notification to internal parties (senior management, union).


Security
Immediate Action
   o Responds to all Code Whites
   o Responds to calls requesting assistance (non code Whites)
   o Promotes and facilitate timely intervention as appropriate
   o Facilitate investigation and follow-up of corrective actions and recommend
       corrective measures where appropriate
Notification
   o Ensures timely reporting to external emergency/policing/fire services.
   o Ensures timely notification of internal parties (senior management).

Support (Individual)
   o Provide support when communications with external emergency/ policing/fire
     services is necessary.
Support (Colleagues/Patients/Clients /etc.)
   o Provide support when communications with external emergency/ policing/ fire/ city
     services is necessary.


Risk Manager
Immediate Action
   o Verifies individuals involved are receiving appropriate care as required
   o Verifies the reporting of and documentation of the incident, including completion
       of incident reporting forms (patient, visitor and employee)
   o Verifies preservation of evidence has occurred if applicable
   o In collaboration with the manager/supervisor, ensures that the incident has been
       reported to the appropriate individuals, e.g. Director, Vice President, Chief of Staff,
       coroner, etc.
   o Available for consultation as required throughout the reporting, investigating and
       management of the incident
Notification
   o In consultation with SJHH Executive, notifies police as required
   o Consults with hospital legal counsel as required
   o Notifies insurance company if patient/visitor injured
Support (Individual)
   o In collaboration with Manager, Occupational Health and Safety, is available to
       support affected individuals.

                                                                                     Page 10
   Support (Colleagues/Patients/Clients/etc.)
     o Ensures appropriate supports have been offered to affected individuals, including
        patients/clients /clients and visitors.

    Union Representative
In accordance with the individual Union-specific standards:
    Immediate Action
       o Provides immediate support to the member, as required.
       o Is available to the member, throughout the process.
     Notification
       o Notifies Union Executive as required.
    Support (Individual)
       o Is available for ongoing support and consultation to the member as requested
    Support (Colleagues/Patients/Clients/etc.)
       o Is available for ongoing support and consultation to the members as requested.

   Learner
   Immediate Action
      o Removes self and others to a safe area if appropriate
      o Calls Code White if appropriate
      o Calls 911 if appropriate
      o Remains calm, do not panic
   Notification
      o Notifies immediately his/ her clinical educator/ preceptor (specifically speaks to
          clinical educator/ preceptor) and/ or Professional Practice Leader/ Advisor or
          delegate. Should page clinical educator/preceptor if not available in person.
   Assessment/Treatment
      o The learner obtains medical/ nursing assessment/ consultation from Employee
          Health Office nurse/ physician, family practitioner or emergency department with
          the assistance of the clinical educator/ preceptor and/ or Professional Practice
          Leader/Advisor/ delegate.
   Support (Individual)
      o The Professional Practice Leader/ Advisor/ delegate is available for assistance as
          required by the learner.
   Support (Others)
      o The Professional Practice Leader/ Advisor/ delegate is available to provide support
          to clinical educator/preceptor/other learners.
   Documentation
      o Completes the employee/descriptive section of the Employee Incident Report.

   Professional Practice Leader/Advisor or Delegate
   Immediate Action
      o Provides immediate support to the learner, as required.
      o Is available to the learner, throughout the process.
   Notification
      o Reports all incidents to the Academic Services Coordinator               and   the
          College/University/School/Vocational School of the learner.

                                                                                  Page 11
         o For serious incidents      or “Critical injuries”     immediately notifies the VP,
            Professional Advisory Committee and Manager OH&S. Note: For Critical injuries
            scene must not be disturbed.
      Assessment/Treatment
         o Facilitates medical/ nursing assessment/ treatment of persons involved (EHO
            nurse/physician; 911, emergency, etc.).
      Support (Individual)
         o Facilitates contact with supports identified by the learner.
      Support (Others)
         o In consultation with clinical team, reviews and assesses the needs of other
            learners and clinical educators/ preceptors present at time of incident in order to
            provide the appropriate support.
      Documentation
         o Completes the manager/delegate section of the Employee Incident Report
         o Ensures that the descriptive section of the Employee Incident Report is complete

References:

   A guide to the development of a Workplace Violence Prevention Program, Ontario Safety
   Association for Community & Healthcare (OSACH)
   Canadian Centre for Occupational Health and Safety
   Definition of Bullying, Ontario Nurses’ Association 2006
   Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers,
   Occupational Safety & Health Administration (OSHA),
   Health and Safety in the Home Care Environment, Health Care Health and Safety Association
   of Ontario and Workplace Safety and Insurance Board, 2003
   Health Care and Residential Facilities Regulation, 67/93
   Nonviolent Crisis Intervention: Participant Workbook, Crisis Prevention Institute (CPI), 1987
   Occupational Health and Safety Act, 1990
   Ontario Human Rights Act
   Ontario Ministry of Labour – Occupational Health and Safety Branch
   Violence in the Workplace: A Guide for ONA Members; Ontario Nurses’ Associate, 2003
   Violence in the Workplace Prevention Guide, 2nd Edition, 2001
   Violence: Occupational Hazards in Hospital, National Institute for Occupational Health and
   Safety, 2002
   Workplace Violence Prevention Program, Health Care Health and Safety Association (HCHSA)
   of Ontario, 2001

Developed in Collaboration with:
Prevention of Violence in the Workplace Task Force

Developed in Consultation With:
  Joint Occupational Health & Safety Committees
  Professional Advisory Council

Policy Review:
This policy and the associated PVW program will be reviewed April 2007.
                                                                                       Page 12
The follow ing appendices are excerpts from: Ontario Safety Association for
Community Healthcare ( OSACH) document “A guide to the development of a
Workplace Violence Prevention Program” and are provided as guidelines.

Appendix A – Preparing for a Meeting with a Potentially Violent Client

Appendix B – Criminal Harassment or Stalking

Appendix C – Dealing with Threats

Appendix D – Domestic Violence

Appendix E – Harassment (Racial, Sexual, Personal and Workplace Bullying)

Appendix F – Point-of-Care Staff Work Practice Assessment

Appendix G – Recognizing and Responding to Stages of Violence

Appendix H – Violence Among Employees

Appendix I – Weapons

Appendix J – Work-Related Travel Procedures




                                                                            Page 13